Case2
“Camera – Ready”
Neal Lehrman, DDS, MS
A 62 year old Caucasian female presented for evaluation and treatment of an apparent pyogenic granuloma on the margin of the maxillary left central incisor. Duration of the lesion had been for 2 months and the patient reported that it had “appeared out of nowhere.”
A review of medical history revealed no significant findings and indeed peri-apical x-ray of the area was wnl. The patient had seen another periodontist who had advised her that excision and biopsy of the area was indicated and that in all likelihood, additional surgery to restore the gingival architecture would be necessary. In her case, given the location of the lesion, a tunneling procedure /SECTG, but outcome was uncertain as the soft tissue defect encompassed both straight labial aspect of the tooth as well as crossing over the mesial line angle.
As with all peri-plastic procedures in the esthetic zone, care must be taken to leave the patient as symmetrical as possible in order to not create an uneven “sight0line”.
Rather than remove the offending tissue, a LANAP approach was utilized. True to the principles of LANAP, in which “effecting “ the tissue, rather than “resecting “ the tissue was utilized, we were able to create an environment in which the laser energy removed enough of the lesion and allowed the body to continue the healing on its own. LPT protocol was followed and 183j @4w were used in total. Once the thermogenic clot was achieved, occlusal adjustment was performed and oral hygiene instructions were given to the patient.
Post-operative healing was uneventful, and in 2 weeks time the lesion had all but disappeared and the patient reported no pain or swelling during that time. As this was an isolated lesion, follow up will be on a PRN basis.
What was accomplished here, though, was interesting as it further concretizes the idea that the body wants to heal itself, if only we get out of the way. In a sense.. similar to LANAP for infectious periodontitis, if we can shift the balance of disease and tip the scale towards regeneration, the body will usually do the rest.
